A controlled study evaluated the efficacy of brain-machine-interface (BMI) training combined with physiotherapy in chronic stroke patients with severe hand weakness. Thirty-two patients were randomly assigned to two groups: one received BMI training with contingent movements of orthoses based on sensorimotor rhythms (SMR), while the other received sham training with random movements. Both groups underwent identical physiotherapy. Results showed significant improvements in upper limb motor function (cFMA scores) in the BMI group compared to the control group, with a 3.41-point difference (p=0.018). These improvements correlated with increased functional MRI (fMRI) lateralization index and electromyography (EMG) activity in the paretic hand. Placebo expectancy scores were similar in both groups. The study suggests that BMI training enhances physiotherapy outcomes by promoting motor learning through real-time feedback, leading to functional improvements in motor function. The findings indicate that BMI training can be an effective adjunct to behavioral physiotherapy in chronic stroke rehabilitation, particularly for patients with limited residual movement. The study highlights the importance of neural activity modulation and cortical reorganization in motor recovery.A controlled study evaluated the efficacy of brain-machine-interface (BMI) training combined with physiotherapy in chronic stroke patients with severe hand weakness. Thirty-two patients were randomly assigned to two groups: one received BMI training with contingent movements of orthoses based on sensorimotor rhythms (SMR), while the other received sham training with random movements. Both groups underwent identical physiotherapy. Results showed significant improvements in upper limb motor function (cFMA scores) in the BMI group compared to the control group, with a 3.41-point difference (p=0.018). These improvements correlated with increased functional MRI (fMRI) lateralization index and electromyography (EMG) activity in the paretic hand. Placebo expectancy scores were similar in both groups. The study suggests that BMI training enhances physiotherapy outcomes by promoting motor learning through real-time feedback, leading to functional improvements in motor function. The findings indicate that BMI training can be an effective adjunct to behavioral physiotherapy in chronic stroke rehabilitation, particularly for patients with limited residual movement. The study highlights the importance of neural activity modulation and cortical reorganization in motor recovery.